A vascular catheter apparatus for penetration through tissue and for cardiac stimulation, and a methods thereof, are disclosed. The apparatus includes a tubular member having a lumen, and a blunt-end stylet within the lumen. An actuation mechanism causes axial movement of the stylet relative to the catheter tube such that the blunt end of the stylet separate tissue for passage of the catheter through the bored tissue. The stylet itself, or an additional stylet, includes a proximal electrode adapted to be oriented in a cardiac chamber and a distal electrode adapted to be oriented adjacent to the epicardium of the heart to cause cardiac stimulation.
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7. A vascular catheter apparatus for penetrating tissue comprising:
a catheter having a lumen therein; a penetration means within said lumen, said penetration means having a distal end; an actuation means for movement of said penetration means relative to said catheter such that said distal end of said penetration means penetrates the tissue for passage through the tissue; an optical sensing means adjacent said distal end of said penetration means; and an optical receiving means for receiving signals from said optical sensing means.
9. A vascular catheter apparatus for blunt boring through cardiac muscle and vascular wall tissue comprising:
a catheter having a lumen therein and having a proximal end and a distal end, said distal end being tapered; a penetration means within said lumen, said penetration means having a blunt distal end with helical threads; and an actuation means for repeated axial movement of said penetration means relative to said catheter such that said distal end of said penetration means penetrates the cardiac muscle and vascular wall tissue for passage through the tissue.
5. A vascular catheter apparatus for penetrating tissue comprising:
a catheter having a lumen therein; a penetration means within said lumen, said penetration means having a distal end; an actuation means for movement of said penetration means relative to said catheter such that said distal end of said penetration means penetrates the tissue for passage through the tissue; and an external tubular sleeve having a internal diameter greater than the external diameter of said catheter, said external tubular sleeve adapted to be placed over said catheter and through the tissue.
8. A vascular catheter apparatus for penetrating tissue comprising:
a catheter having a lumen therein; a penetration means within said lumen, said penetration means having a distal end; an actuation means for movement of said penetration means relative to said catheter such that said distal end of said penetration means penetrates the tissue for passage through the tissue; said actuation means comprising a handle and a spring-biased means on said handle and attached to said penetration means, wherein movement of said spring-biased means relative to said handle causes axial movement of said penetration means relative to said catheter.
15. A vascular catheter apparatus for blunt boring through cardiac muscle and vascular wall tissue comprising:
a catheter having a lumen therein; a penetration means within said lumen, said penetration means having a blunt distal end with helical threads; an optical sensing means adjacent said distal end of said penetration means; an optical receiving means for receiving signals from said optical sensing means; and an actuation means for repeated axial movement of said penetration means relative to said catheter such that said distal end of said penetration means penetrates the cardiac muscle and vascular wall tissue for passage through the tissue.
10. A vascular catheter apparatus for blunt boring through cardiac muscle and vascular wall tissue comprising:
a catheter having a lumen therein; a penetration means within said lumen, said penetration means having a blunt distal end with helical threads; an external tubular sleeve having an internal diameter greater than the external diameter of said catheter, said external tubular sleeve adapted to be placed over said catheter and through the tissue; and an actuation means for repeated axial movement of said penetration means relative to said catheter such that said distal end of said penetration means penetrates the cardiac muscle and vascular wall tissue for passage through the tissue.
6. A vascular catheter apparatus for penetrating tissue comprising:
a catheter having a lumen therein; a penetration means within said lumen, said penetration means having a distal end; an actuation means for movement of said penetration means relative to said catheter such that said distal end of said penetration means penetrates the tissue for passage through the tissue; and an internal tubular sleeve having an external diameter less than the internal diameter of said catheter and having an internal diameter greater than the eternal diameter of said penetration means, said internal tubular sleeve adapted to be placed in said catheter and over said penetration means for passage through the tissue.
18. A vascular catheter apparatus for blunt boring through cardiac muscle and vascular wall tissue comprising:
a catheter having a lumen therein; a penetration means within said lumen, said penetration means having a blunt distal end with helical threads; and an actuation means for repeated axial movement of said penetration means relative to said catheter such that said distal end of said penetration means penetrates the cardiac muscle and vascular wall tissue for passage through the tissue, said actuation means comprising a handle and a spring-biased means on said handle and attached to said penetration means, wherein movement of said spring-biased means relative to said handle causes axial movement of said penetration means relative to said catheter.
1. A vascular catheter apparatus for blunt boring through inner cardiac tissue and into the pericardial space comprising:
a catheter having a lumen therein, said catheter having a proximal end and a tapered distal end, said catheter insertible through the vascular system to rest in a cardiac chamber adjacent to inner cardiac tissue; a stylet within said lumen, said stylet having a proximal end and a blunt probe as a distal end; and a probe actuation means including a handle and a spring-biased means on said handle and attached to said proximal end of said stylet wherein movement of said spring-biased means relative to said handle causes axial movement of said stylet relative to said catheter such that said blunt probe separates inner cardiac tissue and for passage through the bored tissue and into the pericardial space.
11. A vascular catheter apparatus for penetrating blunt boring through cardiac muscle and vascular wall tissue comprising:
a catheter having a lumen therein; a penetration means within said lumen, said penetration means having a blunt distal end with helical threads; an internal tubular sleeve having an external diameter less than the internal diameter of said catheter and having an internal diameter greater than the external diameter of said penetration means, said internal tubular sleeve adapted to be placed in said catheter and over said penetration means for passage through the tissue; and an actuation means for repeated axial movement of said penetration means relative to said catheter such that said distal end of said penetration means penetrates the cardiac muscle and vascular wall tissue for passage through the tissue.
2. The vascular catheter apparatus of
an external tubular sleeve having an internal diameter greater than the external diameter of said catheter, said external tubular sleeve adapted to be placed over said catheter and through the bored tissue.
3. The vascular catheter apparatus of
an internal tubular sleeve having an external diameter less than the internal diameter of said catheter and having an internal diameter greater than the external diameter of said stylet, said internal tubular sleeve adapted to be placed in said catheter and over said stylet for passage through the bored tissue.
4. The vascular catheter apparatus of
an optical sensing means adjacent said blunt probe of said stylet; and an optical receiving means for receiving signals from said optical sensing means showing the location of said blunt probe in the cardiac chambers, the cardiac tissue and pericardial space.
12. The vascular catheter apparatus of
13. The vascular catheter apparatus of
a biasing means adjacent said distal end of said internal tubular sleeve, said biasing means urging said distal end radially outward from said catheter tube to contact the tissue when said internal tubular sleeve is in the tissue.
14. The vascular catheter apparatus of
teeth adjacent said distal end of said internal tubular sleeve for gripping the tissue when said internal tubular sleeve is in the penetrated tissue.
16. The vascular catheter apparatus of
17. The vascular catheter apparatus of
19. The vascular catheter apparatus of
20. The vascular catheter apparatus of
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The present invention pertains to a vascular catheter assembly for penetration through tissue and for cardiac stimulation, and methods thereof. More particularly, the present invention pertains to a tubular member containing a stylet and insertable into a cardiac chamber for blunt boring of an opening through the endocardial, myocardial and epicardial tissue for passage of the tubular member and stylet into the pericardial space. Either the boring stylet itself, or a different stylet can be passed through this opening to provide cardiac stimulation.
The pericardium of the heart includes the pericardial sac, a tough, fibrous membrane surrounding the heart; the pericardial space, a void filled with serous fluid; and the epicardial layer, the exterior surface of the heart. In addition to the pericardium, the heart has the myocardium, a middle, muscular layer; and the endocardium, an inner layer on the walls of the heart's atrial and ventricular chambers.
In order to gain access to the epicardial surface of the heart, for ablation of arrhythmic areas, implantation of defibrillation electrodes or mapping of the epicardial surface, for example, a thoractomy is often required.
In addition to the time, expense, operating and infection risks, and patient discomfort associated with opening the patient's thorax, another problem exists in gaining access to the epicardium by breaching the pericardial sac. Opening the pericardial sac allows the serous fluid to escape and blood to enter the pericardial space inviting additional cardiac complications such as infection and irritation.
A need thus exists for a catheter-based apparatus and method for vascular entry into the body, and particularly into the heart, that circumvents major thoracic surgery and minimizes the amount of organ bleeding that occurs when the stylet passes through organ tissue layers.
The present invention is a vascular catheter assembly for penetration through tissue (more specifically blunt boring) and for cardiac stimulation, and methods thereof. The vascular catheter assembly includes a tubular member having a lumen, and a blunt-end stylet within the lumen. A stylet activation mechanism causes axial movement of the stylet relative to the catheter tube such that the blunt-end of the stylet separates tissue for passage of the tubular member through the created tissue bore.
In the preferred embodiment of the present invention, the stylet includes a proximal electrode adapted to be oriented in a cardiac chamber and a distal electrode adapted to be oriented adjacent to the epicardium of the heart. However, the present invention also contemplates a stylet distinct from the stylet having the blunt end. This separate stylet is inserted through the created tissue bore after the stylet having the blunt end is withdrawn.
In another aspect of the preferred embodiment, the tubular member has a tapered distal end to initiate the boring and to augment passage of the tubular member and stylet through the tissue bore.
In another aspect of the preferred embodiment, an external tubular sleeve having an internal diameter greater than the external diameter of the tubular member is placed over the tubular member in the tissue bore to enlarge the bore.
In another aspect of the preferred embodiment, an internal tubular sleeve having an external diameter less than the internal diameter of the tubular member, and having an internal diameter greater than the external diameter of the blunt-end stylet is placed over the blunt-end stylet and in the tubular member. The internal tubular sleeve is a skirt placed in the tissue bore to stabilize the bore, and preferably has a biased distal end with teeth that grip the tissue when the internal tubular sleeve is ejected from the tubular member by axial movement of the blunt end stylet.
In another aspect of the preferred embodiment, an optical sensor, either in the blunt end of the stylet or in the distal end of the tubular member, sends signals to an optical receiver denoting stylet position in the heart.
In another aspect of the preferred embodiment, an electrocardiographic sensor on the blunt end of the stylet or in the distal end of the tubular member sends varied signals to an electrocardiographic receiver denoting stylet position in the heart.
In another aspect of the preferred embodiment, the stylet actuation mechanism includes a handle and a spring-biased lever attached to the handle by a fulcrum and connected to the blunt-end stylet. Movement of the spring-biased lever relative to the handle causes axial movement of the blunt-end stylet relative to the tubular member.
In an alternate embodiment, the blunt-end stylet has helical threads for engagement with the tissue.
These and other features of the present invention will be more fully appreciated when considered in the light of the following specification and drawings in which:
FIG 1a is a perspective view of the vascular catheter apparatus of the present invention;
FIG 1b is an enlarged view of the tapered cylindrical walls of the distal end of the vascular catheter apparatus of the present invention;
FIG 1c is a perspective view of the vascular catheter apparatus of the present invention having a thumb-activated handle mechanism;
FIG. 2 is a cross-section of the distal end of the vascular catheter apparatus of FIG. 1 taken at lines 2--2;
FIG. 3a is a simplified, cross-sectional view of a heart of a patient with a vascular catheter apparatus of the present invention boring through the right ventricle;
FIG. 3b is a simplified, cross-sectional view of a heart of a patient with a vascular catheter apparatus of the present invention passing through the right-ventricle and into the pericardial space;
FIG. 4a is a simplified, cross-sectional view of a heart chamber of a patient prior to implantation of a bore stabilizing sleeve by the vascular catheter apparatus of the present invention;
FIG. 4b is a simplified cross-sectional view of a heart chamber of a patient after implantation of a bore stabilizing sleeve by the vascular catheter apparatus of the present invention;
FIG. 5 is a distal end view of the vascular catheter apparatus of the present invention showing optical and ECG sensors;
FIG. 6 is a simplified, cross-sectional view of a heart of a patient with the stylet of the present invention including cardiac stimulating electrodes;
FIG. 7a is a side view of the distal end of another embodiment of the vascular catheter apparatus of the present invention showing helical threads on the stylet end; and
FIG. 7b is a distal end view of the embodiment of FIG. 7a.
The present invention is a vascular catheter apparatus for penetration of tissue and for cardiac stimulation, and methods thereof.
Referring to FIGS 1a, 1b, and 2, vascular catheter apparatus 2 includes tubular member (or catheter) 4 having proximal end 6 and distal end 8. Distal end 8 preferably has tapered cylindrical walls 10, as shown in FIG. 2, to augment the passage of tubular member 4 through tissue.
Lumen 12 extends axially through tubular member 4 and contains stylet 14, a thin wire capable of maintaining its lengthwise integrity when pushed through an artery or vein. Stylet 14 has proximal end 16 and distal end 18. Stylet 14 is removable from lumen 12 for passage of medical instruments, such as defibrillation electrodes, biopsy probes, or ablation devices, through lumen 12. Referring specifically to FIG. 2, distal end 18 of stylet 14 is a blunt, rounded probe preferably having a cross-sectional area greater than the cross-sectional area of lumen 12 at tapered cylindrical walls 10. Thus, upon axial movement of stylet 14 relative to tubular member 4, blunt, rounded distal end 18 contacts tapered cylindrical walls 10 adjacent catheter distal end 8 and expands catheter distal end 8 to pass through tubular member 4. As shown in FIG 1b, it is thus readily apparent that tubular member 4, and specifically, tapered cylindrical walls 10 of distal end 8, is formed from a thin layer of a semi-elastomeric polymer, such as polyethylene, that allows passage of blunt, rounded distal end 18 of stylet 14, and possesses sufficient resilience to return to its original shape when blunt, rounded distal end 18 is retracted. In a preferred embodiment, as shown in FIG 1b, tapered cylindrical walls 10 are comprised of a plurality of conic sections 10a that open radially by passage of blunt, rounded distal end 18. Conic sections 10a, when preferably comprised of polyethylene or the like, have "living hinges" known in the art that allow the above described radial movement. When blunt, rounded distal end 18 is not biasing conic sections 10a outwardly, conic sections 10a preferably contact each other to form an integral cone.
Attached to proximal end 6 of tubular member 4 is probe actuation mechanism 20, preferably comprised of a spring-biased lever 22 attached to a handle 24 by a fulcrum 26. Lever 22 includes a cavity 28 on the end of lever 22 adjacent to catheter proximal end 6, and through which stylet 14 passes. Screw 30, threadedly engaged in end 32 of lever 22, intersects cavity 28 to grip stylet 14, adjacent proximal end 16, in lever 22. In the spring-biased position of lever 22, blunt, rounded distal end 18 of stylet 14 preferably protrudes slightly from catheter distal end 8, for example, by about 1 mm to about 2 mm. Operating lever 22 against the spring bias preferably retracts blunt, rounded distal end 18 of stylet 14 into tubular member 4.
In an alternate embodiment, shown in FIG 1c, probe actuation mechanism 20 includes elongated tube 13 with an axial bore 15 having a spring-biased, thumb operated shaft 17 therein. The shaft 17 is adapted to grip the proximal end 16 of stylet 14 for axial movement of stylet 14 relative to tubular member 4 when the shaft 17 is plunged into the bore 15 of the probe actuation mechanism 20 by the user's thumb.
Operation of the present invention is now described, with specific reference to blunt boring with an intravenous catheter member from the inner wall of a cardiac chamber to the pericardial space. Referring to FIG. 2 and 3a, tubular member 4 and stylet 14, having blunt, rounded distal end 18, are passed through the vascular system to a vein 34 that leads into the desired heart chamber, for example, the right ventricle 36.
Distal end 8 of tubular member 4 is then pressed against the endocardium 38 of the right ventricle 36 such that tapered cylindrical walls 10 initiate entry of the tubular member 4 into the inner heart tissue and augment passage of tubular member 4 through the tissue as shown in FIG. 2.
Next, probe actuation mechanism 20 is repeatedly operated to cyclically drive the blunt, rounded distal end 18 of stylet 14 against the heart's inner tissue as stylet 14 moves axially relative to tubular member 4. Additionally, tapered cylindrical walls 10, and specifically, conic sections 10a, if present, are biased radially outwardly against the heart's inner tissue as stylet 14 is moved axially relative to tubular member 4. In this manner, blunt, rounded distal end 18 pushes aside the fibrous inner heart tissue and associated cardiac veins as it passes through the endocardium 38, the myocardium 40, and the epicardium 42, as shown in FIG. 3a. Pressure applied by the operator along tubular member 4 causes impact by the blunt, rounded distal end 18 with the heart's inner tissue and urges tubular member 4 and stylet 14 through the tissue bore 46 created by the blunt, rounded distal end 18.
Note that the ball-like tip design of blunt, rounded distal end 18 prevents cutting, slicing, upbraiding, or other severing of major cardiac tissue cellular structure in order to minimize cardiac bleeding. Additionally, once the tubular member 4 and stylet 14 have passed through the tissue bore 46, they may encounter blood vessels that are usually near the exterior heart wall. The blunt shape of distal end 18 pushes aside, rather than severs, these caridac wall vessels.
Each impact of blunt, rounded distal end 18 temporarily damages the heart's inner tissue, electrically stimulating the heart. Thus, in applying the pulsating action to blunt, rounded distal end 18 with probe actuation mechanism 20, the operator should avoid a frequency relative to that of the heart's pulsation that would induce arrhythmias caused by this stimulation. Specifically, impact and catheter advancement should be synchronized to the electrical or mechanical activity of the heart. Proper timing also aids in efficient boring through the heart's inner tissue because the impact of the blunt, rounded distal end 18 with the inner tissue is timed to occur when the tissue tension is low due to the normal heart contraction cycle.
Referring now to FIG. 3b, after tubular member 4 and stylet 14 have passed through tissue bore 46 in right ventricle 36, tubular member 4 and stylet 14 enter pericardial space 48. The breakthrough of tissue bore 46 may be somewhat violent and abrupt, resulting in tubular member 4 and stylet 14 passing therethrough with force sufficient to propel stylet 14 against pericardial sac 50. However, the shape of blunt, rounded distal end 18 of stylet 14 prevents piercing of pericardial sac 50 by stylet 14.
Depending upon the size of tubular member 4, the amount of inner tissue damage done by boring, and whether the catheter placement is permanent or temporary, a stabilizing sleeve may need to be inserted into tissue bore 46. FIG. 3b shows a stabilization sleeve in the form of external tubular sleeve 52. External tubular sleeve 52 has an internal diameter greater than the external diameter of tubular member 4 such that external tubular sleeve 52 may be placed over tubular member 4 in coaxial alignment. In this manner, external tubular sleeve 52 can pass through tissue bore 46, enlarging and stabilizing the bore. It is readily apparent that successive external tubular sleeves 52 can be placed over preceding sleeves in order to further enlarge the tissue bore 46. External tubular sleeve 52 can be secured in tissue bore 46 with teeth or threads 54. Further securing external tubular sleeve 52 to tissue bore 46 are lips 56, preformed biased edges of external tubular sleeve 52 that extend radially outward from tissue bore 46.
Referring now to FIGS. 4a and 4b, internal tubular sleeve 58 may also be employed to stabilize tissue bore 46. Referring to FIG. 4a, internal tubular sleeve 58 has an external diameter less than the internal diameter of tubular member 4, and has an internal diameter greater than the external diameter of reduced diameter, shouldered distal end 60 of stylet 14. Thus, internal tubular sleeve 58 is loaded into tubular member 4 over reduced diameter, shouldered distal end 60. Upon reinserting of tubular member 4 through tissue bore 44 and implementation of probe actuation mechanism 20, the axial movement of stylet 14 relative to tubular member 4 will urge internal tubular sleeve 58 out of tubular member 4 due to the contact between the shoulders 62 of reduced diameter, shouldered distal end 60 and the proximal ends 64 of the internal tubular sleeve 58.
As shown in FIG. 4b, the distal ends 66 of internal tubular sleeve 58 are preferably biased and have teeth 68 such that, upon ejection from tubular member 4, distal ends 66 are urged radially outward from tissue bore 46 to grip tissue bore 46 with teeth 68.
Referring now to FIG. 5, in the preferred embodiment of the present invention an electrocardiographic sensor 70 is located in the tip of the blunt, rounded distal end 18 of stylet 14 or in the distal end 8 of tubular member 4. Wires passing through tubular member 4 connect ECG sensor 70 to an ECG receiver and an ECG monitor known in the art. The electrically conductive ECG sensor 70 senses electrical ECG signals in the heart tissue. The operator can thus ascertain the relative position of blunt, rounded distal end 18 of stylet 14 in the heart. Specifically, a normal ECG pattern will be sensed by ECG sensor 70 when it contacts the heart's inner tissue. Furthermore, when the blunt, rounded distal end 18 of stylet 14 invades the heart's inner tissue, the ECG signal changes configuration from a normal noninvaded tissue ECG signal to a damaged tissue ECG signal. Once the blunt, rounded distal end 18 passes through tissue bore 44 and into the pericardial space 48, the electrical response signal changes dramatically because ECG sensor 70 is no longer in contact with electrically active cardiac inner tissue.
Still referring to FIG. 5, in the preferred embodiment of the present invention, an optical sensor 72a, such as a fiber optic fiber, is located in the edge of the distal end 8 of catheter 14. Alternatively, the optical sensor, 72b, may be located in the tip of the blunt rounded distal end 18 of stylet 14. A conventional light source and fiber optic receiver known in the art are attached to optical sensor 72a or 72b. The operator can thus ascertain the relative location of blunt, rounded distal end 18 of stylet 14 in the heart. When the blunt, rounded distal end 18 is in the right ventricle 36, the operator views the reddish interior of the ventricle through the optical sensor 72a or 72b. When the blunt, rounded distal end 18 has bored into the inner tissue of the heart, the optical sensor 72a or 72b would transmit a substantially black signal. Once the blunt, rounded distal end 18 has bored through the inner tissue and passed into the pericardial space 48, the optical sensor 72 would transmit a signal showing a white or light environment characteristic of the serous fluid and pericardial sac.
After creation of tissue bore 46 by the impact of blunt, rounded distal end 18 of stylet 14 with the heart's inner tissue, and after insertion of either external tubular sleeve 52 or internal tubular sleeve 58 if required, stylet 14 can be removed and the following surgical devices, and/or procedures, could be employed through tubular member 4: a fiber optic catheter examination of the pericardial space, heart surface and blood vessels; a biopsy probe for heart tissue samples; surgical repairs such as reinforcement of a ventricular aneurism by stitches on the pericardial surface; and ablation of arrhythmogenic tissues.
Additionally, in the most preferred embodiment of the present invention, after creation of tissue bore 46, cardiac stimulation can be implemented with the below described stylet having electrodes. The type of cardiac stimulation that can be induced with the present invention includes defibrillation and conversion of tachycardia. It is important to note that this stylet with electrodes can either be stylet 14 having blunt rounded distal end 18, or alternatively, can be a separate stylet inserted through tissue bore 46 after removal of stylet 14.
Referring specifically to FIG. 6, electrode stylet 76, being either stylet 14 capable of tissue boring or a stylet subsequently inserted through tissue bore 46, includes proximal electrode 78 and distal electrode 80. While electrode stylet 76 is termed a stylet because it is an elongate member inserted through tubular member 4, electrode stylet 76 preferably includes a lumen 82 and has a closed distal end 84 such that a secondary stylet 86 can be inserted through proximal end 88 and into lumen 82 and distal electrode 80 for the reasons described below.
Proximal electrode 78 and distal electrode 80 are comprised of electrical conductive, biologically inert materials known in the art, such as platinum irridium or stainless steel. Either proximal electrode 78 or distal electrode 80 may be the positive pole for cardiac stimulation, with the other of proximal electrode 78 and distal electrode 80 being the negative pole. The energy received by proximal electrode 78 and distal electrode 80 from a power source known in the art (not shown) is preferably between about 10 microjoules and about 40 joules.
Proximal electrode 78 is linearly oriented on electrode stylet 76 such that proximal electrode 78 resides in the right atrium, right ventricle or vena cava. Most preferably, proximal electrode 78 resides in the right atrium or vena cava. Distal electrode 80 is located adjacent to the distal end 84 of electrode stylet 76. Distal electrode 80 is preferably oriented adjacent to the epicardium 42, and can be located at any portion of the epicardium 42 depending upon the desired result of the cardiac stimulation (e.g., defibrillation or conversion of tachycardia). In order to achieve the desired placement of distal electrode 80 on a specific portion of epicardium 42 while ensuring that proximal electrode 78 resides in the desired cardiac chamber, the length of electrode stylet 76 between proximal electrode 78 and distal electrode 80 is varied accordingly.
In order to insert electrode stylet 76 through tissue bore 46, electrode stylet 76 is passed through tubular member 4 until the orientation of proximal electrode 78 in the desired cardiac chamber and the orientation of distal electrode 80 on the desired portion of epicardium 42 is achieved. Specifically, if electrode stylet 76 is required to follow a contour of the heart, as shown in FIG. 6, in order to properly place distal electrode 80, cathode 4 and electrode stylet 76, both being preferably pliable, may be bent accordingly.
Secondary stylet 86 is employed to facillitate passage of distal electrode 80 through tissue bore 46. Distal electrode 80 preferably has a large surface area in order to maximize cardiac stimulation. In its most preferred shape, distal electrode 80 is spiral. Distal electrode 80 is comprised of a resilient material that is biased in this spiral shape. However, when secondary stylet 86 is passed through lumen 82 of electrode stylet 76 and into distal electrode 80, secondary stylet 86 straightens distal electrode 80 for passage through tissue bore 46. After distal electrode 80 is placed at the desired location adjacent to epicardium 42, secondary stylet 86 is withdrawn from distal electrode 80 and lumen 82, and distal electrode 80 returns to its spiral shape.
After proper orientation of proximal electrode 78 and distal electrode 80, electrode stylet 76 can be secured in tissue bore 46 with, for example, external tubular sleeve 52 or internal tubular sleeve 58.
Referring now to FIGS. 7a and 7b, in another embodiment of the present invention, instead of being substantially smooth, the blunt, rounded distal end 18 of stylet 14 has helical threads 74 thereon. Helical threads 74 are preferably fine, shallow threads so that they do not excessively rip or tear cardiac tissue and blood vessels. The helix angle of threads 74 are preferably between about 25 degrees and about 50 degrees. Upon insertion of tapered cylindrical walls 10 into the endocardium 38 of the right ventricle 36 (as previously discussed), the stylet 14 is rotated clockwise or counterclockwise instead of, or in addition to, its axial movement by probe actuation mechanism 20. The probe actuation mechanism embodiment of FIG. 1c is most conveniently employed to accomplish this rotation. The rotational motion of stylet 14 causes helical threads to bore into the endocardium 38, the myocardium 40, and the epicardium 42, thus creating tissue bore 46 and carrying tubular member 4 and the remainder of stylet 14 therethrough.
While the preferred embodiment pertains to blunt boring of tissue, other types of mechanical tissue penetration, such as, for example, cutting, scraping, probing, piercing and avulsing are contemplated within the scope of the subject invention. Additionally, chemical, electrical and/or thermal penetration means may be employed. While particular embodiments of the present invention have been described in some detail herein above, changes and modifications may be made in the illustrated embodiments without departing from the spirit of the invention.
Patent | Priority | Assignee | Title |
10004388, | Sep 01 2006 | Intuitive Surgical Operations, Inc | Coronary sinus cannulation |
10004558, | Jan 12 2009 | Cilag GmbH International | Electrical ablation devices |
10004875, | Aug 24 2005 | C. R. Bard, Inc. | Stylet apparatuses and methods of manufacture |
10046139, | Aug 20 2010 | C. R. Bard, Inc. | Reconfirmation of ECG-assisted catheter tip placement |
10064540, | Feb 02 2005 | Intuitive Surgical Operations, Inc | Visualization apparatus for transseptal access |
10070772, | Sep 01 2006 | Intuitive Surgical Operations, Inc | Precision control systems for tissue visualization and manipulation assemblies |
10076382, | Oct 25 2010 | MEDTRONIC ARDIAN LUXEMBOURG S.A.R.L. | Catheter apparatuses having multi-electrode arrays for renal neuromodulation and associated systems and methods |
10092172, | May 08 2007 | Intuitive Surgical Operations, Inc. | Complex shape steerable tissue visualization and manipulation catheter |
10092291, | Jan 25 2011 | Ethicon Endo-Surgery, Inc | Surgical instrument with selectively rigidizable features |
10098527, | Feb 27 2013 | Cilag GmbH International | System for performing a minimally invasive surgical procedure |
10098691, | Dec 18 2009 | Cilag GmbH International | Surgical instrument comprising an electrode |
10105121, | Nov 26 2007 | C. R. Bard, Inc. | System for placement of a catheter including a signal-generating stylet |
10105141, | Jul 14 2008 | Cilag GmbH International | Tissue apposition clip application methods |
10111705, | Oct 10 2008 | Intuitive Surgical Operations, Inc. | Integral electrode placement and connection systems |
10165962, | Nov 26 2007 | C. R. Bard, Inc. | Integrated systems for intravascular placement of a catheter |
10179009, | Aug 07 2012 | Needleless transseptal access device and methods | |
10206709, | May 14 2012 | Cilag GmbH International | Apparatus for introducing an object into a patient |
10220162, | Jan 07 2014 | Pericardial access device and its methods of use | |
10226178, | Nov 18 2008 | SYNC-RX, LTD | Automatic reduction of visibility of portions of an image |
10231643, | Jun 12 2009 | Bard Access Systems, Inc. | Apparatus and method for catheter navigation and tip location |
10231753, | Nov 26 2007 | C. R. Bard, Inc. | Insertion guidance system for needles and medical components |
10238418, | Nov 26 2007 | C. R. Bard, Inc. | Apparatus for use with needle insertion guidance system |
10258406, | Feb 28 2011 | Cilag GmbH International | Electrical ablation devices and methods |
10271762, | Jun 12 2009 | Bard Access Systems, Inc. | Apparatus and method for catheter navigation using endovascular energy mapping |
10278588, | Feb 02 2005 | Intuitive Surgical Operations, Inc. | Electrophysiology mapping and visualization system |
10278761, | Feb 28 2011 | Cilag GmbH International | Electrical ablation devices and methods |
10278849, | Feb 07 2008 | Intuitive Surgical Operations, Inc. | Stent delivery under direct visualization |
10307061, | Mar 08 2007 | SYNC-RX, LTD | Automatic tracking of a tool upon a vascular roadmap |
10314603, | Nov 25 2008 | Cilag GmbH International | Rotational coupling device for surgical instrument with flexible actuators |
10314649, | Aug 02 2012 | Ethicon Endo-Surgery, Inc | Flexible expandable electrode and method of intraluminal delivery of pulsed power |
10335131, | Oct 23 2006 | Intuitive Surgical Operations, Inc | Methods for preventing tissue migration |
10342575, | Nov 26 2007 | C. R. Bard, Inc. | Apparatus for use with needle insertion guidance system |
10342598, | Aug 15 2012 | Cilag GmbH International | Electrosurgical system for delivering a biphasic waveform |
10349857, | Jun 12 2009 | Bard Access Systems, Inc. | Devices and methods for endovascular electrography |
10349890, | Jun 26 2015 | C R BARD, INC | Connector interface for ECG-based catheter positioning system |
10362962, | Nov 18 2008 | SYNX-RX, LTD. | Accounting for skipped imaging locations during movement of an endoluminal imaging probe |
10368729, | Feb 02 2005 | Intuitive Surgical Operations, Inc. | Methods and apparatus for efficient purging |
10390685, | Dec 21 2006 | Intuitive Surgical Operations, Inc. | Off-axis visualization systems |
10441136, | Dec 18 2006 | Intuitive Surgical Operations, Inc. | Systems and methods for unobstructed visualization and ablation |
10449330, | Nov 26 2007 | C R BARD, INC | Magnetic element-equipped needle assemblies |
10463237, | Feb 02 2005 | Intuitive Surgical Operations, Inc. | Delivery of biological compounds to ischemic and/or infarcted tissue |
10470643, | Jun 14 2006 | Intuitive Surgical Operations, Inc. | In-vivo visualization systems |
10478248, | Feb 15 2007 | Cilag GmbH International | Electroporation ablation apparatus, system, and method |
10492880, | Jul 30 2012 | Ethicon Endo-Surgery, Inc | Needle probe guide |
10499814, | Mar 08 2007 | SYNC-RX, LTD | Automatic generation and utilization of a vascular roadmap |
10512504, | May 11 2012 | MEDTRONIC ARDIAN LUXEMBOURG S.A.R.L. | Multi-electrode catheter assemblies for renal neuromodulation and associated systems and methods |
10524691, | Nov 26 2007 | C R BARD, INC | Needle assembly including an aligned magnetic element |
10602958, | Nov 26 2007 | C. R. Bard, Inc. | Systems and methods for guiding a medical instrument |
10624695, | May 11 2007 | Intuitive Surgical Operations, Inc. | Visual electrode ablation systems |
10639008, | Oct 08 2009 | C R BARD, INC | Support and cover structures for an ultrasound probe head |
10716528, | Mar 08 2007 | SYNC-RX, LTD. | Automatic display of previously-acquired endoluminal images |
10736690, | Apr 24 2014 | MEDTRONIC IRELAND MANUFACTURING UNLIMITED COMPANY | Neuromodulation catheters and associated systems and methods |
10748289, | Jun 26 2012 | SYNC-RX, LTD | Coregistration of endoluminal data points with values of a luminal-flow-related index |
10751509, | Nov 26 2007 | C R BARD, INC | Iconic representations for guidance of an indwelling medical device |
10772492, | Feb 02 2005 | Intuitive Surgical Operations, Inc. | Methods and apparatus for efficient purging |
10779882, | Oct 28 2009 | Cilag GmbH International | Electrical ablation devices |
10792098, | Mar 15 2013 | MEDTRONIC ARDIAN LUXEMBOURG S.A.R.L. | Helical push wire electrode |
10820885, | Jun 15 2012 | C R BARD, INC | Apparatus and methods for detection of a removable cap on an ultrasound probe |
10849695, | Nov 26 2007 | C. R. Bard, Inc. | Systems and methods for breaching a sterile field for intravascular placement of a catheter |
10863920, | Feb 06 2014 | C. R. Bard, Inc. | Systems and methods for guidance and placement of an intravascular device |
10912488, | Jun 12 2009 | Bard Access Systems, Inc. | Apparatus and method for catheter navigation and tip location |
10966630, | Nov 26 2007 | C. R. Bard, Inc. | Integrated system for intravascular placement of a catheter |
10973584, | Jan 19 2015 | BARD ACCESS SYSTEMS, INC ; ROMEDEX INTERNATIONAL SRL | Device and method for vascular access |
10984531, | Jun 26 2012 | SYNC-RX, LTD | Determining a luminal-flow-related index using blood velocity determination |
10992079, | Oct 16 2018 | BARD ACCESS SYSTEMS, INC | Safety-equipped connection systems and methods thereof for establishing electrical connections |
11000207, | Jan 29 2016 | C R BARD, INC | Multiple coil system for tracking a medical device |
11026630, | Jun 26 2015 | C. R. Bard, Inc. | Connector interface for ECG-based catheter positioning system |
11027101, | Aug 22 2008 | C. R. Bard, Inc. | Catheter assembly including ECG sensor and magnetic assemblies |
11064903, | Nov 18 2008 | SYNC-RX, LTD | Apparatus and methods for mapping a sequence of images to a roadmap image |
11064964, | Mar 08 2007 | SYNC-RX, LTD | Determining a characteristic of a lumen by measuring velocity of a contrast agent |
11103213, | Oct 08 2009 | C. R. Bard, Inc. | Spacers for use with an ultrasound probe |
11116572, | Oct 25 2010 | MEDTRONIC ARDIAN LUXEMBOURG S.A.R.L. | Catheter apparatuses having multi-electrode arrays for renal neuromodulation and associated systems and methods |
11123099, | Nov 26 2007 | C. R. Bard, Inc. | Apparatus for use with needle insertion guidance system |
11134915, | Nov 26 2007 | C. R. Bard, Inc. | System for placement of a catheter including a signal-generating stylet |
11179038, | Mar 08 2007 | SYNC-RX, LTD | Automatic stabilization of a frames of image stream of a moving organ having intracardiac or intravascular tool in the organ that is displayed in movie format |
11197651, | Mar 08 2007 | SYNC-RX, LTD. | Identification and presentation of device-to-vessel relative motion |
11207496, | Aug 24 2005 | C. R. Bard, Inc. | Stylet apparatuses and methods of manufacture |
11213678, | Sep 09 2013 | MEDTRONIC ARDIAN LUXEMBOURG S.A.R.L. | Method of manufacturing a medical device for neuromodulation |
11241325, | Feb 07 2008 | Intuitive Surgical Operations, Inc. | Stent delivery under direct visualization |
11284918, | May 14 2012 | Cilag GmbH International | Apparatus for introducing a steerable camera assembly into a patient |
11317946, | Aug 07 2012 | Needleless transseptal access device and methods | |
11337594, | Sep 01 2006 | Intuitive Surgical Operations, Inc. | Coronary sinus cannulation |
11350815, | Jul 07 2008 | Intuitive Surgical Operations, Inc. | Catheter control systems |
11369356, | Oct 23 2006 | Intuitive Surgical Operations, Inc. | Methods and apparatus for preventing tissue migration |
11376061, | Sep 30 2011 | Covidien LP | Energy delivery device and methods of use |
11399834, | Jul 14 2008 | Cilag GmbH International | Tissue apposition clip application methods |
11406250, | Feb 02 2005 | Intuitive Surgical Operations, Inc. | Methods and apparatus for treatment of atrial fibrillation |
11419517, | Jun 12 2009 | Bard Access Systems, Inc. | Apparatus and method for catheter navigation using endovascular energy mapping |
11464563, | Apr 24 2014 | MEDTRONIC ARDIAN LUXEMBOURG S.A.R.L. | Neuromodulation catheters and associated systems and methods |
11478152, | Feb 02 2005 | Intuitive Surgical Operations, Inc. | Electrophysiology mapping and visualization system |
11484191, | Feb 27 2013 | Cilag GmbH International | System for performing a minimally invasive surgical procedure |
11529070, | Nov 26 2007 | C. R. Bard, Inc. | System and methods for guiding a medical instrument |
11559188, | Dec 21 2006 | Intuitive Surgical Operations, Inc. | Off-axis visualization systems |
11621518, | Oct 16 2018 | Bard Access Systems, Inc. | Safety-equipped connection systems and methods thereof for establishing electrical connections |
11622689, | Nov 14 2008 | Intuitive Surgical Operations, Inc. | Mapping and real-time imaging a plurality of ablation lesions with registered ablation parameters received from treatment device |
11707205, | Nov 26 2007 | C. R. Bard, Inc. | Integrated system for intravascular placement of a catheter |
11779195, | Sep 01 2006 | Intuitive Surgical Operations, Inc. | Precision control systems for tissue visualization and manipulation assemblies |
11779240, | Nov 26 2007 | C. R. Bard, Inc. | Systems and methods for breaching a sterile field for intravascular placement of a catheter |
11819190, | Feb 02 2005 | Intuitive Surgical Operations, Inc. | Methods and apparatus for efficient purging |
11882996, | Jun 14 2006 | Intuitive Surgical Operations, Inc. | In-vivo visualization systems |
11883149, | Nov 18 2008 | SYNC-RX LTD. | Apparatus and methods for mapping a sequence of images to a roadmap image |
11889982, | Feb 02 2005 | Intuitive Surgical Operations, Inc. | Electrophysiology mapping and visualization system |
5439461, | Mar 24 1993 | KARL STORZ GMBH & CO KG | Grip for a surgical instrument |
5873855, | Jan 07 1992 | Arthrocare Corporation | Systems and methods for electrosurgical myocardial revascularization |
6032674, | Jan 07 1992 | Arthrocare Corporation | Systems and methods for myocardial revascularization |
6159225, | Oct 13 1995 | Medtronic Vascular, Inc | Device for interstitial transvascular intervention and revascularization |
6190353, | Oct 13 1995 | Medtronic Vascular, Inc | Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures |
6283951, | Oct 11 1996 | Medtronic Vascular, Inc | Systems and methods for delivering drugs to selected locations within the body |
6302875, | Oct 11 1996 | Medtronic Vascular, Inc | Catheters and related devices for forming passageways between blood vessels or other anatomical structures |
6325813, | Aug 18 1998 | Boston Scientific Scimed, Inc | Method and apparatus for stabilizing vascular wall |
6423080, | Feb 13 1997 | Boston Scientific Scimed, Inc | Percutaneous and hiatal devices and methods for use in minimally invasive pelvic surgery |
6544230, | Mar 31 1998 | Medtronic Vascular, Inc | Catheters, systems and methods for percutaneous in situ arterio-venous bypass |
6613062, | Oct 29 1999 | Medtronic, Inc. | Method and apparatus for providing intra-pericardial access |
6655386, | Oct 13 1995 | Medtronic Vascular, Inc | Transluminal method for bypassing arterial obstructions |
6685648, | Oct 11 1996 | Medtronic Vascular, Inc | Systems and methods for delivering drugs to selected locations within the body |
6746464, | Oct 13 1995 | Medtronic Vascular, Inc | Device, system and method for interstitial transvascular intervention |
6752814, | Feb 13 1997 | Boston Scientific Scimed, Inc | Devices for minimally invasive pelvic surgery |
6855143, | Jun 13 1997 | Arthrocare Corporation | Electrosurgical systems and methods for recanalization of occluded body lumens |
6915806, | May 10 1993 | Arthrocare Corporation | Method for harvesting graft vessel |
7059330, | Oct 11 1996 | Medtronic Vascular, Inc | Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures |
7094230, | Oct 11 1996 | Medtronic Vascular, Inc. | Systems and methods for delivering drugs to selected locations within the body |
7134438, | Oct 13 1995 | Medtronic Vascular, Inc | Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures |
7207988, | Oct 29 1999 | Medtronic Inc. | Method and apparatus for providing intra-pericardial access |
7407506, | Oct 13 1995 | Medtronic Vascular, Inc | Device, system and method for interstitial transvascular intervention |
7413540, | Feb 13 1997 | Boston Scientific Scimed, Inc | Devices for minimally invasive pelvic surgery |
7422585, | Jan 07 1992 | Arthrocare Corporation | System for electrosurgical myocardial revascularization |
7505812, | Jun 13 1997 | Arthrocare Corporation | Electrosurgical system for treating restenosis of body lumens |
7546166, | Nov 29 2001 | Medtronic, Inc | Medical lead designs for lead placement through tissue |
7614999, | Feb 13 1997 | Boston Scientific Scimed, Inc. | Systems, devices, and methods for minimally invasive pelvic surgery |
7621865, | Feb 13 1997 | Boston Scientific Scimed, Inc. | Systems, devices, and methods for minimally invasive pelvic surgery |
7655004, | Feb 15 2007 | Cilag GmbH International | Electroporation ablation apparatus, system, and method |
7670329, | Oct 13 1995 | Medtronic Vascular, Inc. | Systems and methods for delivering drugs to selected locations within the body |
7678132, | Sep 06 2001 | PROMED, INC | Systems and methods for treating septal defects |
7686828, | Sep 06 2001 | PROMED, INC | Systems and methods for treating septal defects |
7691050, | Feb 13 1997 | Boston Scientific Scimed, Inc | Devices for minimally invasive pelvic surgery |
7691052, | Feb 13 1997 | Boston Scientific Scimed, Inc | Devices for minimally invasive pelvic surgery |
7740640, | Sep 06 2001 | PROMED, INC | Clip apparatus for closing septal defects and methods of use |
7758521, | Oct 29 1999 | Medtronic, Inc | Methods and systems for accessing the pericardial space |
7815662, | Mar 08 2007 | Ethicon Endo-Surgery, Inc | Surgical suture anchors and deployment device |
7846172, | Oct 13 1995 | Medtronic Vascular, Inc. | Device, system and method for interstitial transvascular intervention |
7846179, | Sep 01 2005 | PROMED, INC | Suture-based systems and methods for treating septal defects |
7922738, | Dec 01 2006 | The Board of Trustees of the Leland Stanford Junior University | Devices and methods for accessing the epidural space |
8000807, | Oct 29 1999 | Medtronic, Inc. | Methods and systems for accessing the pericardial space |
8029504, | Feb 15 2007 | Cilag GmbH International | Electroporation ablation apparatus, system, and method |
8037591, | Feb 02 2009 | Ethicon Endo-Surgery, Inc | Surgical scissors |
8050746, | Feb 02 2005 | Intuitive Surgical Operations, Inc | Tissue visualization device and method variations |
8070759, | May 30 2008 | Cilag GmbH International | Surgical fastening device |
8070826, | Sep 07 2001 | PROMED, INC | Needle apparatus for closing septal defects and methods for using such apparatus |
8075572, | Apr 26 2007 | Ethicon Endo-Surgery, Inc | Surgical suturing apparatus |
8078266, | Oct 25 2005 | Intuitive Surgical Operations, Inc | Flow reduction hood systems |
8083708, | Oct 13 1995 | Medtronic Vascular, Inc. | Systems and methods for delivering drugs to selected locations within the body |
8100922, | Apr 27 2007 | Ethicon Endo-Surgery, Inc | Curved needle suturing tool |
8114072, | May 30 2008 | Ethicon Endo-Surgery, Inc | Electrical ablation device |
8114119, | Sep 09 2008 | Ethicon Endo-Surgery, Inc | Surgical grasping device |
8131350, | Dec 21 2006 | Intuitive Surgical Operations, Inc | Stabilization of visualization catheters |
8137333, | Oct 25 2005 | Intuitive Surgical Operations, Inc | Delivery of biological compounds to ischemic and/or infarcted tissue |
8157834, | Nov 25 2008 | Cilag GmbH International | Rotational coupling device for surgical instrument with flexible actuators |
8172744, | Feb 13 1997 | Boston Scientific Scimed, Inc. | Devices for minimally invasive pelvic surgery |
8172772, | Dec 11 2008 | Ethicon Endo-Surgery, Inc | Specimen retrieval device |
8211125, | Aug 15 2008 | Ethicon Endo-Surgery, Inc | Sterile appliance delivery device for endoscopic procedures |
8221310, | Oct 25 2005 | Intuitive Surgical Operations, Inc | Tissue visualization device and method variations |
8235985, | Aug 31 2007 | Intuitive Surgical Operations, Inc | Visualization and ablation system variations |
8241204, | Aug 29 2008 | Ethicon Endo-Surgery, Inc | Articulating end cap |
8252057, | Jan 30 2009 | Cilag GmbH International | Surgical access device |
8262563, | Jul 14 2008 | Ethicon Endo-Surgery, Inc | Endoscopic translumenal articulatable steerable overtube |
8262655, | Nov 21 2007 | Ethicon Endo-Surgery, Inc | Bipolar forceps |
8262680, | Mar 10 2008 | Ethicon Endo-Surgery, Inc | Anastomotic device |
8317806, | May 30 2008 | Ethicon Endo-Surgery, Inc | Endoscopic suturing tension controlling and indication devices |
8333012, | Oct 10 2008 | Intuitive Surgical Operations, Inc | Method of forming electrode placement and connection systems |
8337394, | Oct 01 2008 | Ethicon Endo-Surgery, Inc | Overtube with expandable tip |
8353487, | Dec 17 2009 | Ethicon Endo-Surgery, Inc | User interface support devices for endoscopic surgical instruments |
8361066, | Jan 12 2009 | Cilag GmbH International | Electrical ablation devices |
8361112, | Jun 27 2008 | Ethicon Endo-Surgery, Inc | Surgical suture arrangement |
8388541, | Nov 26 2007 | C R BARD, INC | Integrated system for intravascular placement of a catheter |
8388546, | Oct 23 2006 | BARD ACCESS SYSTEMS, INC | Method of locating the tip of a central venous catheter |
8403926, | Jun 05 2008 | Ethicon Endo-Surgery, Inc | Manually articulating devices |
8409200, | Sep 03 2008 | Ethicon Endo-Surgery, Inc | Surgical grasping device |
8417321, | Feb 02 2005 | Intuitive Surgical Operations, Inc | Flow reduction hood systems |
8419613, | Feb 02 2005 | Intuitive Surgical Operations, Inc | Tissue visualization device |
8425505, | Feb 15 2007 | Cilag GmbH International | Electroporation ablation apparatus, system, and method |
8437833, | Oct 07 2008 | BARD ACCESS SYSTEMS, INC | Percutaneous magnetic gastrostomy |
8449538, | Feb 15 2007 | Cilag GmbH International | Electroporation ablation apparatus, system, and method |
8463007, | Nov 18 2008 | SYNC-RX, LTD.; SYNC-RX, LTD | Automatic generation of a vascular skeleton |
8475468, | Oct 29 1999 | Medtronic, Inc. | Method and apparatus for providing intra-pericardial access |
8478382, | Feb 11 2008 | C R BARD, INC | Systems and methods for positioning a catheter |
8480657, | Oct 31 2007 | Ethicon Endo-Surgery, Inc | Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ |
8480689, | Sep 02 2008 | Ethicon Endo-Surgery, Inc | Suturing device |
8496574, | Dec 17 2009 | KARL STORZ ENDOVISION, INC | Selectively positionable camera for surgical guide tube assembly |
8506564, | Dec 18 2009 | Ethicon Endo-Surgery, Inc | Surgical instrument comprising an electrode |
8512256, | Oct 23 2006 | Bard Access Systems, Inc. | Method of locating the tip of a central venous catheter |
8529563, | Aug 25 2008 | Ethicon Endo-Surgery, Inc | Electrical ablation devices |
8540694, | Mar 25 1998 | Medtronic Vascular, Inc. | Systems and methods for delivering drugs to selected locations within the body |
8542900, | Nov 18 2008 | SYNC-RX, LTD | Automatic reduction of interfering elements from an image stream of a moving organ |
8568410, | Aug 31 2007 | Ethicon Endo-Surgery, Inc | Electrical ablation surgical instruments |
8579897, | Nov 21 2007 | Ethicon Endo-Surgery, Inc | Bipolar forceps |
8579936, | Jul 05 2005 | PROMED, INC | Centering of delivery devices with respect to a septal defect |
8585596, | Mar 31 1998 | Medtronic Vascular, Inc | Catheters, systems and methods for percutaneous in situ arterio-venous bypass |
8608652, | Nov 05 2009 | Ethicon Endo-Surgery, Inc | Vaginal entry surgical devices, kit, system, and method |
8636641, | Feb 13 1997 | Boston Scientific Scimed, Inc | Devices for minimally invasive pelvic surgery |
8652150, | May 30 2008 | Ethicon Endo-Surgery, Inc | Multifunction surgical device |
8657805, | May 08 2007 | Intuitive Surgical Operations, Inc | Complex shape steerable tissue visualization and manipulation catheter |
8670603, | Nov 18 2008 | SYNC-RX, LTD. | Apparatus and methods for masking a portion of a moving image stream |
8679003, | May 30 2008 | Ethicon Endo-Surgery, Inc | Surgical device and endoscope including same |
8693756, | Nov 18 2008 | SYNC-RX, LTD. | Automatic reduction of interfering elements from an image stream of a moving organ |
8694071, | Feb 12 2010 | Intuitive Surgical Operations, Inc | Image stabilization techniques and methods |
8700130, | Mar 08 2007 | SYNC-RX, LTD | Stepwise advancement of a medical tool |
8709008, | May 11 2007 | Intuitive Surgical Operations, Inc | Visual electrode ablation systems |
8727962, | Feb 13 1997 | Boston Scientific Scimed, Inc | Devices for minimally invasive pelvic surgery |
8727988, | Oct 13 1995 | Medtronic Vascular, Inc. | Tissue penetrating catheters having integral imaging transducers and their methods of use |
8747483, | Sep 07 2001 | Promed, Inc. | Needle apparatus for closing septal defects and methods for using such apparatus |
8753366, | Oct 13 1995 | Medtronic Vascular, Inc. | Catheters and related devices for forming passageways between blood vessels or other anatomical structures |
8758229, | Dec 21 2006 | Intuitive Surgical Operations, Inc | Axial visualization systems |
8758401, | Sep 06 2001 | PROMED, INC | Systems and methods for treating septal defects |
8771260, | May 30 2008 | Ethicon Endo-Surgery, Inc | Actuating and articulating surgical device |
8774907, | Oct 23 2006 | Bard Access Systems, Inc. | Method of locating the tip of a central venous catheter |
8781193, | Nov 18 2008 | SYNC-RX, LTD | Automatic quantitative vessel analysis |
8781555, | Nov 26 2007 | C R BARD, INC | System for placement of a catheter including a signal-generating stylet |
8784336, | Aug 24 2005 | C R BARD, INC | Stylet apparatuses and methods of manufacture |
8790238, | Feb 13 1997 | Boston Scientific Scimed, Inc. | Systems, devices, and methods for minimally invasive pelvic surgery |
8801693, | Oct 29 2010 | C R BARD, INC | Bioimpedance-assisted placement of a medical device |
8814777, | Feb 13 1997 | Boston Scientific Scimed, Inc | Devices for minimally invasive pelvic surgery |
8814845, | Feb 02 2005 | Intuitive Surgical Operations, Inc | Delivery of biological compounds to ischemic and/or infarcted tissue |
8828031, | Jan 12 2009 | Ethicon Endo-Surgery, Inc | Apparatus for forming an anastomosis |
8849382, | Nov 26 2007 | C R BARD, INC | Apparatus and display methods relating to intravascular placement of a catheter |
8852173, | Oct 29 1999 | Medtronic, Inc. | Methods and systems for providing therapies into the pericardial space |
8855744, | Nov 18 2008 | SYNC-RX, LTD. | Displaying a device within an endoluminal image stack |
8858455, | Oct 23 2006 | Bard Access Systems, Inc. | Method of locating the tip of a central venous catheter |
8858609, | Feb 07 2008 | Intuitive Surgical Operations, Inc | Stent delivery under direct visualization |
8888792, | Jul 14 2008 | Cilag GmbH International | Tissue apposition clip application devices and methods |
8894643, | Oct 10 2008 | Intuitive Surgical Operations, Inc | Integral electrode placement and connection systems |
8906035, | Jun 04 2008 | Ethicon Endo-Surgery, Inc | Endoscopic drop off bag |
8939897, | Oct 31 2007 | Ethicon Endo-Surgery, Inc. | Methods for closing a gastrotomy |
8971994, | Feb 11 2008 | C. R. Bard, Inc. | Systems and methods for positioning a catheter |
8986199, | Feb 17 2012 | Ethicon Endo-Surgery, Inc | Apparatus and methods for cleaning the lens of an endoscope |
9005198, | Jan 29 2010 | Ethicon Endo-Surgery, Inc | Surgical instrument comprising an electrode |
9008367, | Nov 18 2008 | SYNC-RX, LTD. | Apparatus and methods for reducing visibility of a periphery of an image stream |
9008754, | Nov 18 2008 | SYNC-RX, LTD | Automatic correction and utilization of a vascular roadmap comprising a tool |
9011431, | Jan 12 2009 | Cilag GmbH International | Electrical ablation devices |
9014453, | Nov 18 2008 | SYNC-RX, LTD. | Automatic angiogram detection |
9026197, | Nov 18 2008 | SYNC-RX, LTD | Apparatus and methods for determining a plurality of local calibration factors for an image |
9028483, | Dec 18 2009 | Cilag GmbH International | Surgical instrument comprising an electrode |
9049987, | Mar 17 2011 | Cilag GmbH International | Hand held surgical device for manipulating an internal magnet assembly within a patient |
9055906, | Jun 14 2006 | Intuitive Surgical Operations, Inc | In-vivo visualization systems |
9078662, | Jul 03 2012 | Cilag GmbH International | Endoscopic cap electrode and method for using the same |
9095313, | Nov 18 2008 | SYNC-RX, LTD. | Accounting for non-uniform longitudinal motion during movement of an endoluminal imaging probe |
9101286, | Nov 18 2008 | SYNC-RX, LTD. | Apparatus and methods for determining a dimension of a portion of a stack of endoluminal data points |
9101735, | Jul 07 2008 | Intuitive Surgical Operations, Inc | Catheter control systems |
9125578, | Jun 12 2009 | Bard Access Systems, Inc. | Apparatus and method for catheter navigation and tip location |
9144394, | Nov 18 2008 | SYNC-RX, LTD. | Apparatus and methods for determining a plurality of local calibration factors for an image |
9155452, | Apr 27 2007 | Intuitive Surgical Operations, Inc | Complex shape steerable tissue visualization and manipulation catheter |
9155587, | May 11 2007 | Intuitive Surgical Operations, Inc | Visual electrode ablation systems |
9192287, | Oct 25 2005 | Intuitive Surgical Operations, Inc | Tissue visualization device and method variations |
9211107, | Nov 07 2011 | C R BARD, INC | Ruggedized ultrasound hydrogel insert |
9216065, | Mar 08 2007 | SYNC-RX, LTD.; SYNC-RX, LTD | Forming and displaying a composite image |
9220526, | Nov 25 2008 | Cilag GmbH International | Rotational coupling device for surgical instrument with flexible actuators |
9226648, | Dec 21 2006 | Intuitive Surgical Operations, Inc | Off-axis visualization systems |
9226772, | Jan 30 2009 | Ethicon Endo-Surgery, Inc | Surgical device |
9233241, | Feb 28 2011 | Cilag GmbH International | Electrical ablation devices and methods |
9254169, | Feb 28 2011 | Cilag GmbH International | Electrical ablation devices and methods |
9265443, | Oct 23 2006 | Bard Access Systems, Inc. | Method of locating the tip of a central venous catheter |
9277957, | Aug 15 2012 | Cilag GmbH International | Electrosurgical devices and methods |
9305334, | Jun 23 2011 | SYNC-RX, LTD | Luminal background cleaning |
9308052, | Nov 18 2008 | SYNC-RX, LTD | Pre-deployment positioning of an implantable device within a moving organ |
9314323, | Feb 13 1997 | Boston Scientific Scimed, Inc | Systems, devices and methods for minimally invasive pelvic surgery |
9314620, | Feb 28 2011 | Ethicon Endo-Surgery, Inc | Electrical ablation devices and methods |
9332893, | Feb 02 2005 | Intuitive Surgical Operations, Inc. | Delivery of biological compounds to ischemic and/or infarcted tissue |
9339206, | Jun 12 2009 | BARD ACCESS SYSTEMS, INC | Adaptor for endovascular electrocardiography |
9345422, | Oct 23 2006 | Bard Acess Systems, Inc. | Method of locating the tip of a central venous catheter |
9345858, | Mar 31 1998 | Medtronic Vascular, Inc. | Catheters, systems and methods for percutaneous in situ arterio-venous bypass |
9375164, | Jul 29 2010 | SYNC-RX, LTD | Co-use of endoluminal data and extraluminal imaging |
9375268, | Feb 15 2007 | Cilag GmbH International | Electroporation ablation apparatus, system, and method |
9415188, | Oct 29 2010 | C R BARD, INC | Bioimpedance-assisted placement of a medical device |
9427255, | May 14 2012 | Cilag GmbH International | Apparatus for introducing a steerable camera assembly into a patient |
9427576, | Oct 07 2009 | Sorin CRM SAS | Epicardial screw lead for stimulation / defibrillation implantable by a guide catheter inserted into a pericardial space |
9445734, | Jun 12 2009 | BARD ACCESS SYSTEMS, INC | Devices and methods for endovascular electrography |
9456766, | Nov 26 2007 | C R BARD, INC | Apparatus for use with needle insertion guidance system |
9468364, | Nov 14 2008 | Intuitive Surgical Operations, Inc | Intravascular catheter with hood and image processing systems |
9492097, | Nov 26 2007 | C R BARD, INC | Needle length determination and calibration for insertion guidance system |
9510732, | Oct 25 2005 | Intuitive Surgical Operations, Inc | Methods and apparatus for efficient purging |
9521961, | Nov 26 2007 | C R BARD, INC | Systems and methods for guiding a medical instrument |
9526401, | Feb 02 2005 | Intuitive Surgical Operations, Inc | Flow reduction hood systems |
9526440, | Nov 26 2007 | C.R. Bard, Inc. | System for placement of a catheter including a signal-generating stylet |
9532724, | Jun 12 2009 | Bard Access Systems, Inc. | Apparatus and method for catheter navigation using endovascular energy mapping |
9545290, | Jul 30 2012 | Ethicon Endo-Surgery, Inc | Needle probe guide |
9549685, | Nov 26 2007 | C. R. Bard, Inc. | Apparatus and display methods relating to intravascular placement of a catheter |
9554716, | Nov 26 2007 | C R BARD, INC | Insertion guidance system for needles and medical components |
9572623, | Aug 02 2012 | Ethicon Endo-Surgery, Inc | Reusable electrode and disposable sheath |
9629571, | Mar 08 2007 | SYNC-RX, LTD. | Co-use of endoluminal data and extraluminal imaging |
9636031, | Nov 26 2007 | C.R. Bard, Inc. | Stylets for use with apparatus for intravascular placement of a catheter |
9649048, | Nov 26 2007 | C R BARD, INC | Systems and methods for breaching a sterile field for intravascular placement of a catheter |
9675413, | Apr 08 2002 | MEDTRONIC ARDIAN LUXEMBOURG S.A.R.L. | Methods and apparatus for renal neuromodulation |
9681823, | Nov 26 2007 | C. R. Bard, Inc. | Integrated system for intravascular placement of a catheter |
9707035, | Apr 08 2002 | MEDTRONIC ARDIAN LUXEMBOURG S.A.R.L. | Methods for catheter-based renal neuromodulation |
9717415, | Nov 18 2008 | SYNC-RX, LTD | Automatic quantitative vessel analysis at the location of an automatically-detected tool |
9788885, | Aug 15 2012 | Cilag GmbH International | Electrosurgical system energy source |
9788888, | Jul 03 2012 | Cilag GmbH International | Endoscopic cap electrode and method for using the same |
9814522, | Apr 06 2010 | Intuitive Surgical Operations, Inc | Apparatus and methods for ablation efficacy |
9833169, | Oct 23 2006 | Bard Access Systems, Inc. | Method of locating the tip of a central venous catheter |
9839372, | Feb 06 2014 | C R BARD, INC | Systems and methods for guidance and placement of an intravascular device |
9855096, | May 11 2012 | MEDTRONIC ARDIAN LUXEMBOURG S.A.R.L. | Multi-electrode catheter assemblies for renal neuromodulation and associated systems and methods |
9855384, | Mar 08 2007 | SYNC-RX, LTD | Automatic enhancement of an image stream of a moving organ and displaying as a movie |
9883910, | Mar 17 2011 | Cilag GmbH International | Hand held surgical device for manipulating an internal magnet assembly within a patient |
9888961, | Mar 15 2013 | MEDTRONIC ARDIAN LUXEMBOURG S.A.R.L. | Helical push wire electrode |
9888969, | Mar 08 2007 | SYNC-RX LTD. | Automatic quantitative vessel analysis |
9901714, | Aug 22 2008 | C R BARD, INC | Catheter assembly including ECG sensor and magnetic assemblies |
9907513, | Oct 07 2008 | Bard Access Systems, Inc. | Percutaneous magnetic gastrostomy |
9968256, | Mar 08 2007 | SYNC-RX LIMITED | Automatic identification of a tool |
9974509, | Nov 18 2008 | SYNC-RX LTD. | Image super enhancement |
9999371, | Nov 26 2007 | C. R. Bard, Inc. | Integrated system for intravascular placement of a catheter |
D699359, | Aug 09 2011 | C R BARD, INC | Ultrasound probe head |
D724745, | Aug 09 2011 | C R BARD, INC | Cap for an ultrasound probe |
D754357, | Aug 09 2011 | C. R. Bard, Inc. | Ultrasound probe head |
Patent | Priority | Assignee | Title |
4166469, | Dec 13 1977 | LITTLEFORD,ELIZABETH H | Apparatus and method for inserting an electrode |
4281660, | Oct 18 1978 | Method for fixing pervenous electrode in atrial pacing and device therefor | |
4309994, | Feb 25 1980 | Cardiovascular cannula | |
4401433, | Jun 13 1980 | LUTHER MEDICAL PRODUCTS, INC | Apparatus for advancing oversized catheter through cannula, and the like |
4445509, | Feb 04 1982 | BOSTON SCIENTIFIC CORPORATION NORTHWEST TECHNOLOGY CENTER, INC | Method and apparatus for removal of enclosed abnormal deposits |
4525157, | Jul 28 1983 | MANRESA, INC , A NJ CORP | Closed system catheter with guide wire |
4602645, | Dec 16 1982 | C. R. Bard, Inc. | Atrio-ventricular pacing catheter |
4624265, | Jul 24 1985 | GE. SV. IN. S.R.l. | Electro-catheter used in physiological cardiac stimulation simulative of the auriculo-ventricular sequence, featuring active engagement of the cardiac muscle |
4652256, | Oct 29 1985 | MANRESA, INC , 740 HILLSDALE AVENUE, HILLSDALE, NEW JERSEY 07642 A CORP OF NEW JERSEY | Closed system catheter with guide wire |
4664120, | Jan 22 1986 | Pacesetter, Inc | Adjustable isodiametric atrial-ventricular pervenous lead |
4681117, | Feb 15 1983 | Intracardiac catheter and a method for detecting myocardial ischemia | |
4790825, | Sep 05 1986 | Electro Catheter Corporation; ELECTRO-CATHETER CORPORATION, A CORP OF NEW JERSEY | Closed chest cannulation method and device for atrial-major artery bypass |
4804359, | Oct 23 1987 | Research Medical, Inc. | Cardiovascular cannula and obturator |
4821735, | Jan 22 1986 | ITAMAR MEDICAL CM 1997 LTD | Method and apparatus for detecting myocardial ischemia |
4926858, | May 30 1984 | Advanced Cardiovascular Systems, INC | Atherectomy device for severe occlusions |
4979939, | May 14 1984 | Surgical Systems & Instruments, Inc. | Atherectomy system with a guide wire |
4991578, | Apr 04 1989 | Pacesetter, Inc | Method and system for implanting self-anchoring epicardial defibrillation electrodes |
5078723, | May 08 1989 | Medtronic, Inc. | Atherectomy device |
5127917, | Jun 01 1989 | SCHNEIDER EUROPE A G | Probe, especially for the recanalization of occlusions, and catheter arrangement with such a probe |
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May 16 1994 | ALFERNESS, CLIFTON A | INCONTROL, INC | ASSIGNMENT OF ASSIGNORS INTEREST SEE DOCUMENT FOR DETAILS | 007007 | /0045 | |
Feb 02 1999 | INCONTROL, INC | Cardiac Pacemakers, Inc | ASSIGNMENT OF ASSIGNORS INTEREST SEE DOCUMENT FOR DETAILS | 009781 | /0901 |
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